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Flashcards in Non Depolarizing NMBs Deck (67)
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1

What are the chemical properties of NDMBs?

Quaternary ammonium
-steroid derivatives or benzylisoquinolines

2

Tell me about the Benzylisoquinolines? Which ones are they? What is different about their metabolism?

Mivacurium, Cisatracurium, Atracurium
-WATER SOLUBLE
-inhibits uptake into hepatocytes leads to lack of liver eliminaton

3

What is the principle route of elimination of the NDMBs?

URINARY

4

Which NDMBs have biliary excretion in addition to renal?

Vecuronium
Rocuronium

5

How is Atracurium metabolized? Cisatracurium? Mivacurium?

Atracurium:2/3 nonspecific ester hydrolysis and 1/3 Hoffman elimination
Cisatracurium: Hoffman elimination
Mivacurium: plasma cholinesterase

6

Which NDMBs cause histamine release?

Mivacurium
Atracurium
D-tubo

7

Which NDMBs can cause tachycardia?

Mivacurium
Atracurium
D-tubo (reflex tachy)
Panuronium

8

Which NDMBs can cause a drop in BP?

Mivacurium
D-tubo

9

Which NDMB can cause and increase in BP?

Pancuronium

10

Which drugs can prolong the NDMBs?

Antibiotics (aminoglycosides!, tetracycline, clindamycin, Cyclosporine)
Antidysrhythmics (procanamide, Quinidine)
Dantrolene
IAs
Ketamine
Locals
Magnesium sulfate
Ca Channel blockers/corticosteroids (atracurium)

11

What can alter your response to NDMBs?

-hypothermia (prolongs block)
-Acidosis (inhibits hoffman elimination)
-Hypokalemia (prolongs effects)
-Burns (3rd degree bursn >30% of body have resistance to NDMBs (40-60 days post injury

12

What is the intubating dose of Rocuronium?

0.6-1.2 mg/kg

13

What is the Onset of Roc?

60-90 sec (1-2 min)

14

What is the DOA of Roc?

30-90 min (15 - 85 min)

15

What is the e 1/2 Life of Roc?

60-120 min (87 min)

16

What is the maintenance dose of Roc?

0.1-0.2mg/kg

17

What patients should you avoid NDMBs?

-myasthenia gravis
-Hemiparesis/hemiplegia (affected side shows resistance as compared to the unaffected side

18

What is the dose of Vecuronium?

0.08-0.1 mg/kg

19

What is the Maintenance dose of Vec?

0.01-0.015mg/kg q 25-45 min

20

What is the cont. infusion dose of Vec?

0.8-1.2 mcg/kg/min

21

What are the contraindications to NDMBs?

-hypersensitivity
-Liver disease and renal disease are relative contraindications

22

Which patients should you use caution when using Pancuronium?

-pts with underlying CV disease
-hypokalemia, hypermagnesemia, severe hyponatremia, severe hypocalcemia potentiate blockade
-hyperparathyroidism
-geriatric pts
-Burns
-MG/ Myasthenic syndrome
-impaired renal function

23

What is the intubating dose of Pancuronium?

0.1 mg/kg

24

What is the maintenance dose of Pancuronium?

0.01 - 0.02 mg/kg q 20-60min

25

What is a contraindication to giving the benzylquinolines?

-Asthma
-atypical acetylcholinesterase

26

What is the dosage and onset of Mivacurium?

0.15 mg/kg and the onset is 2-3 minutes

27

What is the intubating dose of Cis-Atracurium?

0.1 5- 0.2 mg/kg IV

28

What is the maintenance dose of Cis-atracurium?

0.02 mg/kg IV

29

What is a major side effect of Cis-Atracurium and Mivacurium? When is this a concern?

Laudanosine production which can cause Seizures; may accumulate in Renal failure

30

What is the onset of Cis-Atracurium?

3-5 min (2-3?)